Child Profile

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Print a Copy: After you submit a Child Profile, you can view, download, and print a PDF copy for your records.

You are not required to answer any question that you feel invades your privacy. This form will be used by your child's teacher to gain a better understand of your child and how we can better meet your child’s needs and desires. This form will be placed in your child’s portfolio and will be reviewed by each of your child’s teachers throughout the duration of their time here at Geist Kids Academy. Your child’s portfolio will remain confidential at all times. All portfolios are the property of Geist Kids Academy. Parents/guardians may view their child’s file upon request.

Child's Information

Name

FirstMiddleLast

Usually Called

Gender

Boy

Girl

Date of Birth

Family Information

Father's Name

FirstLast

Occupation

Mother's Name

FirstLast

Occupation

Family Status

Married, living together

Single parent

Separated, child with Father

Divorced, child with Father

Separated, child with Mother

Divorced, child with Mother

Father and stepmother

Child living with grandparents

Mother and stepfather

If divorced or separated, explain legal parenting agreement

Does your child split their time with another parent?

Yes

No

List any other individuals who live in your home

Name

Relationship

Does your child have grandparents nearby?

Yes

No

How often does your child see them?

Child's Activities

Extra curricular activities your child is involved in

Regular responsibilities your child has at home

Child's Interests

Special interests your child has

Pets at home

Interests other family members have that could be used for an activity in the class­room

Personal Background

Fears or anxieties your child has

Steps our staff can take to calm fears or anxieties

Medical issues that may limit play and/or participation in Geist Kids Academy activities